MEDICARE: MR. GEORGE TOWERS ROWLAND III PT, OCS, CERT.MDT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA00248000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	40QA00248000	OTHER	NJ	PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1114929692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE TOWERS ROWLAND III PT, OCS, CERT.MDT

Provider Business Mailing Address
First Line	:	121 LEES LN
Second Line	:
City	:	HADDON TOWNSHIP
State	:	NJ
Zip	:	08107-1030
Country	:	US
Telephone Number	:	856-858-8222
Fax Number	:	856-858-8222

Provider Business Practice Location Address
First Line	:	121 LEES LN
Second Line	:
City	:	HADDON TOWNSHIP
State	:	NJ
Zip	:	08107-1030
Country	:	US
Telephone Number	:	856-858-8222
Fax Number	:	856-858-8222

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2005
Last Update Date	:	04/24/2013

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